Provider Demographics
NPI:1710249701
Name:HARBERT, PETER EDWIN (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:EDWIN
Last Name:HARBERT
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1742 N 175TH PLZ
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68118-6025
Mailing Address - Country:US
Mailing Address - Phone:402-490-8425
Mailing Address - Fax:
Practice Address - Street 1:18101 CHICAGO STREET
Practice Address - Street 2:SUITE #107
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68022
Practice Address - Country:US
Practice Address - Phone:402-590-5365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-14
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE70241223P0221X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist